"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

September 02, 2018

WHO EMRO: Outbreak update – cholera in Yemen, 19 July 2018

Ever since the WHO dashboard for cholera in Yemen vanished, I've had a very hard time finding current numbers. On its page dedicated to epidemic and pandemic-prone diseases, WHO EMRO has fairly recent (August 23) numbers for cholera in Somalia, but nothing for Yemen more recent than this: WHO EMRO | Outbreak update – Cholera in Yemen, 19 July 2018. The full update and then a comment:

19 July 2018 - The Ministry of Public Health and Population of Yemen has reported 2597 suspected cholera cases and three associated deaths during epidemiological week 26 (25 June – 1 July) in 2018. The cumulative total from 27 April 2017 to 1 July 2018 is 1,115,378 suspected cholera cases and 2310 associated deaths (CFR 0.21%). Children under 5 years of age represent 28.8% of the total suspected cases. So far, the cholera outbreak has affected 22 out of 23 governorates and 305 out of 333 districts in Yemen.

At the national level, the trend for the weekly number of cases is stable. The number of reported cases has decreased or remained stable in all governorates for three consecutive weeks, with the exceptions of Amran, Sanaa, Dhamar, Al Bayda, Amanat Al Asimah and Ibb. This week, 14 out of 22 governorates reported new cases, with the highest number coming from Amran (479), Amanat Al Asimah (335), Sanaa (331), and Al Hudaydah (312). Al Hudaydah Governorate accounts for the highest number of suspected cases (163,864 including 286 associated deaths), which represent 14.7 % of the total suspected cholera in the country.

WHO, in coordination with Health and WASH cluster partners, continues to support the Ministry of Public Health and Population of Yemen to contain this outbreak through the strengthening of disease surveillance, including laboratory capacity, case management and improving sanitation.

To date, out of 4459 samples collected, 1157 cases have been confirmed as cholera positive by culture. The latest positive culture was confirmed on 29 June 2018 in Amanat Al Asimah.

WHO and UNICEF, with MOPHP are preparing to conduct an oral cholera vaccination (OCV) campaign in six districts in Al Hudaydah, targeting 823,000 people over age one. The targeted districts are those still reporting laboratory-confirmed cases where improvements to water and sanitation are extremely challenging. OCV will be part of the overall strategy to stop/reduce transmission in these districts.

Bear in mind that Yemen's outbreak is by far the worst in the world, much worse even than Haiti's. It is also a major reason why Yemen is considered the world's greatest current humanitarian disaster. You would think that cholera in Yemen would merit constant surveillance and reporting, rather than burying weeks-old "updates" deep in WHO EMRO's website.

It's especially perplexing because WHO EMRO was providing daily detailed reports on the cholera dashboard as recently as late June. Then it vanished without explanation. I would hate to think that they were axed due to pressure from the Saudis, whose air attacks have largely destroyed Yemen's water and sanitation infrastructure.

Meanwhile, OCHA is reporting the possibility of a third wave of cholera:

The number of suspected cholera cases has increased in Yemen, suggesting that the country might face a possible third wave of the epidemic. The current rains have increased the risk. WHO reports increased presentations at health facilities, including severe cases that require further observation, and some deaths. Twenty-two deaths in 16 districts are under investigation.

Since April 2017, more than 1.1 million suspected cholera cases and 2,310 associated deaths have been reported in Yemen. Twenty-one of the 22 governorates (305 out of 333 districts) have been affected. In the last three weeks, 209 districts have reported suspected cholera cases, including Shada District in Sa’ada Governorate which reported its first ever case. The outbreak is the most serious on record.

In the high-risk areas of Al Hudaydah and Ibb governorates, nearly 400,000 people were vaccinated in early August. Supported by UNICEF, WHO, the World Bank and The Vaccine Alliance (Gavi), the vaccination campaign achieved 68 per cent coverage. WHO suggests that more targeting activities need to be done. This includes augmenting water and sanitation activities, communications about risk, ensuring that the second vaccination dose is administered in time and adding more priority districts that need the first dose.

WASH Cluster partners have scaled up cholera prevention and response through rapid response teams and various interventions in cholera risk areas. From January to June, the Cluster reached 7.1 million people through one or a combination of emergency water supply, sanitation, basic hygiene and awareness activities.

UNICEF has prepositioned treatment supplies for over half million cases in three warehouses and in health offices. Stand-by partnership agreements and memoranda of understanding with health offices are being finalised.

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WHO EMRO: Outbreak update – cholera in Yemen, 19 July 2018

Ever since the WHO dashboard for cholera in Yemen vanished, I've had a very hard time finding current numbers. On its page dedicated to epidemic and pandemic-prone diseases, WHO EMRO has fairly recent (August 23) numbers for cholera in Somalia, but nothing for Yemen more recent than this: WHO EMRO | Outbreak update – Cholera in Yemen, 19 July 2018. The full update and then a comment:

19 July 2018 - The Ministry of Public Health and Population of Yemen has reported 2597 suspected cholera cases and three associated deaths during epidemiological week 26 (25 June – 1 July) in 2018. The cumulative total from 27 April 2017 to 1 July 2018 is 1,115,378 suspected cholera cases and 2310 associated deaths (CFR 0.21%). Children under 5 years of age represent 28.8% of the total suspected cases. So far, the cholera outbreak has affected 22 out of 23 governorates and 305 out of 333 districts in Yemen.

At the national level, the trend for the weekly number of cases is stable. The number of reported cases has decreased or remained stable in all governorates for three consecutive weeks, with the exceptions of Amran, Sanaa, Dhamar, Al Bayda, Amanat Al Asimah and Ibb. This week, 14 out of 22 governorates reported new cases, with the highest number coming from Amran (479), Amanat Al Asimah (335), Sanaa (331), and Al Hudaydah (312). Al Hudaydah Governorate accounts for the highest number of suspected cases (163,864 including 286 associated deaths), which represent 14.7 % of the total suspected cholera in the country.

WHO, in coordination with Health and WASH cluster partners, continues to support the Ministry of Public Health and Population of Yemen to contain this outbreak through the strengthening of disease surveillance, including laboratory capacity, case management and improving sanitation.

To date, out of 4459 samples collected, 1157 cases have been confirmed as cholera positive by culture. The latest positive culture was confirmed on 29 June 2018 in Amanat Al Asimah.

WHO and UNICEF, with MOPHP are preparing to conduct an oral cholera vaccination (OCV) campaign in six districts in Al Hudaydah, targeting 823,000 people over age one. The targeted districts are those still reporting laboratory-confirmed cases where improvements to water and sanitation are extremely challenging. OCV will be part of the overall strategy to stop/reduce transmission in these districts.

Bear in mind that Yemen's outbreak is by far the worst in the world, much worse even than Haiti's. It is also a major reason why Yemen is considered the world's greatest current humanitarian disaster. You would think that cholera in Yemen would merit constant surveillance and reporting, rather than burying weeks-old "updates" deep in WHO EMRO's website.

It's especially perplexing because WHO EMRO was providing daily detailed reports on the cholera dashboard as recently as late June. Then it vanished without explanation. I would hate to think that they were axed due to pressure from the Saudis, whose air attacks have largely destroyed Yemen's water and sanitation infrastructure.

Meanwhile, OCHA is reporting the possibility of a third wave of cholera:

The number of suspected cholera cases has increased in Yemen, suggesting that the country might face a possible third wave of the epidemic. The current rains have increased the risk. WHO reports increased presentations at health facilities, including severe cases that require further observation, and some deaths. Twenty-two deaths in 16 districts are under investigation.

Since April 2017, more than 1.1 million suspected cholera cases and 2,310 associated deaths have been reported in Yemen. Twenty-one of the 22 governorates (305 out of 333 districts) have been affected. In the last three weeks, 209 districts have reported suspected cholera cases, including Shada District in Sa’ada Governorate which reported its first ever case. The outbreak is the most serious on record.

In the high-risk areas of Al Hudaydah and Ibb governorates, nearly 400,000 people were vaccinated in early August. Supported by UNICEF, WHO, the World Bank and The Vaccine Alliance (Gavi), the vaccination campaign achieved 68 per cent coverage. WHO suggests that more targeting activities need to be done. This includes augmenting water and sanitation activities, communications about risk, ensuring that the second vaccination dose is administered in time and adding more priority districts that need the first dose.

WASH Cluster partners have scaled up cholera prevention and response through rapid response teams and various interventions in cholera risk areas. From January to June, the Cluster reached 7.1 million people through one or a combination of emergency water supply, sanitation, basic hygiene and awareness activities.

UNICEF has prepositioned treatment supplies for over half million cases in three warehouses and in health offices. Stand-by partnership agreements and memoranda of understanding with health offices are being finalised.